Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most o...Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.展开更多
Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted i...Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.展开更多
目的探讨腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后镇痛的影响。方法选择2022年8月至2023年8月在东莞市妇幼保健院接受子宫下段剖宫产的产妇72例进行随机对照试验。采用随机数字表法将入组产妇分为对照组与观察组,每...目的探讨腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后镇痛的影响。方法选择2022年8月至2023年8月在东莞市妇幼保健院接受子宫下段剖宫产的产妇72例进行随机对照试验。采用随机数字表法将入组产妇分为对照组与观察组,每组36例。对照组(40.42±9.43)岁,体质量指数(23.59±7.49)kg/cm^(2);观察组(41.91±9.32)岁,体质量指数(23.62±7.51)kg/cm^(2)。两组产妇均采用腰硬联合麻醉,术毕后实施超声引导腹横肌平面阻滞;观察组在胎儿娩出后静脉注射艾司氯胺酮0.5 mg/kg,对照组则在同一时间段静脉注射等量生理盐水。记录两组产妇术后2、4、6、12、24、48 h静息疼痛视觉模拟量表(VAS)评分;记录两组产妇首次患者自控镇痛(PCA)时间、48 h PCA总次数、氟比洛芬酯补救镇痛例数;记录两组产妇48 h下床活动次数、首次肛门排气时间;记录两组产妇眩晕、噩梦等镇痛相关不良反应发生情况。符合正态分布的计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验。结果观察组术后6、12 h静息VAS评分低于对照组[(1.12±0.37)分比(1.74±0.45)分、(1.14±0.38)分比(1.78±0.47)分,均P<0.05];观察组首次PCA时间长于对照组[(9.82±1.94)h比(5.13±1.47)h,P<0.05];观察组48 h PCA总次数、氟比洛芬酯补救镇痛例数低于对照组[(7.14±1.44)次比(10.62±2.92)次、2.78%(1/36)比25.00%(9/36),均P<0.05]。观察组48 h下床活动次数多于对照组[(10.27±2.13)次比(8.14±1.68)次,P<0.05];观察组首次肛门排气时间短于对照组[(8.52±1.63)h比(12.35±2.41)h,P<0.05];观察组眩晕发生率低于对照组[5.56%(2/36)比27.78%(10/36),P<0.05]。结论腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后的镇痛效果显著,可降低术后VAS评分,延长首次PCA时间,减少PCA总次数,促进术后恢复。展开更多
目的:探讨子宫下段全层缝合术在剖宫产中的应用及对子宫切口憩室(PCSD)形成的影响。方法:选取2020年6月—2022年6月于我院行剖宫产产妇78例,按随机数字表法分为两组,各39例。对照组予以子宫下段分层缝合术,观察组予以子宫下段全层缝合...目的:探讨子宫下段全层缝合术在剖宫产中的应用及对子宫切口憩室(PCSD)形成的影响。方法:选取2020年6月—2022年6月于我院行剖宫产产妇78例,按随机数字表法分为两组,各39例。对照组予以子宫下段分层缝合术,观察组予以子宫下段全层缝合术。比较两组手术相关指标、术后并发症、PCSD发生率、PCSD容积及周围厚度。结果:两组手术时间、24h出血量、恶露持续天数及产后血红素相比,差异无统计学意义(P>0.05);观察组术后并发症总发生率、PCSD发生率较对照组低(P<0.05);观察组子宫切口憩室容积为(0.31±0.04)mm2,低于对照组的(0.45±0.06)mm2,子宫切口憩室周围厚度为(7.35±0.76)mm,高于对照组的(6.02±0.62)mm( P <0.05)。 结论: 子宫下段全层缝合术在剖宫产术中应用效果更佳,可降低并发症风险,减少PCSD形成。展开更多
文摘Background: The success rate of vaginal birth after cesarean section with a single cesarean scar is greater than 50%, the lack of the information about the safety of vaginal birth after cesarean delivery pushes most of obstetricians to increase the num ber of cesarean sections following a previous cesarean section. Guidelines for Vaginal birth after cesarean (VBAC) indicate that TOLAC offers women with no contraindications and one previous transverse low-segment cesarean. The objective of the current study was to study the outcome of trial of labour after caesarean section (TOLAC), the indications for emergency repeat cesarean section and to determine the maternal and fetal prognosis in vaginal birth after caesarian section (VBAC) at Tshikaji Mission Hospital. Patients, Material and Methods: This is a retrospective study of the records of 126 women were selected to undergo the TOLAC in the department of gynecology and obstetrics at the Tshikaji Mission Hospital over the period from January 1<sup>st</sup> to December 31<sup>st</sup>, 2021. The data on demography, antenatal care, labour and delivery and outcomes were collected from the maternity unit of this hospital. The data were analyzed using SPSS version 2.0. Results: The TOLAC in 126 studied women. The course of work allowed vaginal delivery 107 parturient women, a success rate of successful VBAC of 85% after the TOLAC. The repeat emergency cesarean section was necessary for delivery in 15% of cases for failed TOLAC. There was no maternal mortality, but we recorded one fetal death or 0.8% of perinatal mortality, 2 cases of cicatricial dehiscence, the incidence of 1.6%. Maternal morbidity after delivery on cicatricial uterus was dominated by postpartum hemorrhages, with 19 cases or 15.1% of cases. Cervical dilatation of more than 3 cm at the time of admission, the parity more than 3 and were the significant factors in favor of a successful VBAC. Birth weight of more than 3500 g, fetal distress and malpresentation were associated with a lower success rate of VBAC. The TOLAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. Conclusion: Pregnancy on a cicatricial uterus represents a high-risk pregnancy. Trial of VBAC in selected cases has great importance in the present era of the rising rate of primary CS especially in rural areas. There is a significantly high vaginal birth after caesarian section (VBAC) success rate among selected women undergoing trial of scar in Tshikaji Hospital. TOLAC remains the option for childbirth in low resource settings as Kasai region in DRC. Adequate patient education and counselling in addition to appropriate patient selection for TOLAC remain the cornerstone to achieving high VBAC success rate.
文摘Background: This study aims to evaluate the effects of omission of the bladder flap formation at primary and repeat lower segment CS. Patients and Methods: The current study was randomized controlled trial conducted in Women Health Hospital, Assiut University, Egypt between March 2017 and May 2018 (ClinicalTrial.gov NCT03016273). Patients were divided into: Non bladder flap group: Uterine incision made 1 cm above the vesico-uterine reflection without incision and dissection of the bladder peritoneum and bladder flap group: Standard cesarean section technique with incision and dissection of a bladder flap prior to uterine incision. Results: The study included 150 patients (75 in each arm). The most common indication for CS in both groups was repeated CS. Non-bladder flap group, compared with flap group, showed shorter skin-incision to delivery time and total operative time, and significantly lower mean estimated blood loss and postoperative pain score. Non-bladder flap group, compared with flap group, was more likely to show postoperative microhematuria. The two groups required approximately the same time for post-operative defecation. Conclusion: Omission of bladder flap formation during CS is associated with shorter operative time, less blood loss, less postoperative pain and lower incidence of postoperative hematuria.
文摘目的探讨腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后镇痛的影响。方法选择2022年8月至2023年8月在东莞市妇幼保健院接受子宫下段剖宫产的产妇72例进行随机对照试验。采用随机数字表法将入组产妇分为对照组与观察组,每组36例。对照组(40.42±9.43)岁,体质量指数(23.59±7.49)kg/cm^(2);观察组(41.91±9.32)岁,体质量指数(23.62±7.51)kg/cm^(2)。两组产妇均采用腰硬联合麻醉,术毕后实施超声引导腹横肌平面阻滞;观察组在胎儿娩出后静脉注射艾司氯胺酮0.5 mg/kg,对照组则在同一时间段静脉注射等量生理盐水。记录两组产妇术后2、4、6、12、24、48 h静息疼痛视觉模拟量表(VAS)评分;记录两组产妇首次患者自控镇痛(PCA)时间、48 h PCA总次数、氟比洛芬酯补救镇痛例数;记录两组产妇48 h下床活动次数、首次肛门排气时间;记录两组产妇眩晕、噩梦等镇痛相关不良反应发生情况。符合正态分布的计量资料两组间比较采用独立样本t检验,计数资料两组间比较采用χ^(2)检验。结果观察组术后6、12 h静息VAS评分低于对照组[(1.12±0.37)分比(1.74±0.45)分、(1.14±0.38)分比(1.78±0.47)分,均P<0.05];观察组首次PCA时间长于对照组[(9.82±1.94)h比(5.13±1.47)h,P<0.05];观察组48 h PCA总次数、氟比洛芬酯补救镇痛例数低于对照组[(7.14±1.44)次比(10.62±2.92)次、2.78%(1/36)比25.00%(9/36),均P<0.05]。观察组48 h下床活动次数多于对照组[(10.27±2.13)次比(8.14±1.68)次,P<0.05];观察组首次肛门排气时间短于对照组[(8.52±1.63)h比(12.35±2.41)h,P<0.05];观察组眩晕发生率低于对照组[5.56%(2/36)比27.78%(10/36),P<0.05]。结论腹横肌平面阻滞联合静脉注射艾司氯胺酮对高龄产妇剖宫产术后的镇痛效果显著,可降低术后VAS评分,延长首次PCA时间,减少PCA总次数,促进术后恢复。
文摘目的:探讨子宫下段全层缝合术在剖宫产中的应用及对子宫切口憩室(PCSD)形成的影响。方法:选取2020年6月—2022年6月于我院行剖宫产产妇78例,按随机数字表法分为两组,各39例。对照组予以子宫下段分层缝合术,观察组予以子宫下段全层缝合术。比较两组手术相关指标、术后并发症、PCSD发生率、PCSD容积及周围厚度。结果:两组手术时间、24h出血量、恶露持续天数及产后血红素相比,差异无统计学意义(P>0.05);观察组术后并发症总发生率、PCSD发生率较对照组低(P<0.05);观察组子宫切口憩室容积为(0.31±0.04)mm2,低于对照组的(0.45±0.06)mm2,子宫切口憩室周围厚度为(7.35±0.76)mm,高于对照组的(6.02±0.62)mm( P <0.05)。 结论: 子宫下段全层缝合术在剖宫产术中应用效果更佳,可降低并发症风险,减少PCSD形成。
